title: One-stage procedure using spinal accessory nerve (XI)-innervated free muscle for facial paralysis reconstruction.
abstract: BACKGROUND
  For the treatment of facial paralysis, functioning free muscle transplantation has become accepted standard treatment. Choice of donor nerve and number of surgery stages, however, are still matters of great debate.
  
  
  METHODS
  Between 2000 and 2011, 36 patients (out of 329; 11 percent) with 42 functioning free muscle transplantations were treated using spinal accessory nerve (XI)-innervated muscle for facial reanimation as a one-stage procedure. Indications included bilateral or unilateral Möbius syndrome, severe postparetic facial synkinesis, and patient preference. Postoperative smile training was required to achieve spontaneous smile. For outcome assessment, patients were evaluated using multidisciplinary methods, including objective smile excursion score (range, 0 to 4), cortical adaptation stage (range, I to V), tickle test, and subjective patient questionnaire and satisfaction score (range, 1 to 5).
  
  
  RESULTS
  Mean smile excursion score improved from 0.5 preoperatively to 3.4 postoperatively. Eighty-three percent of patients were able to perform independent and even spontaneous smile after 1 year of follow-up. Ninety percent of patients had a mean satisfaction score of 3.4 out of 5. However, 50 percent expressed more concern with aesthetic appearance than functional status. There was no functional morbidity of the donor shoulder in daily life.
  
  
  CONCLUSIONS
  The classic two-stage procedure is still the first choice for facial paralysis reconstruction. However, the effectiveness of XI-innervated free muscle for facial reanimation in a one-stage procedure has proven it to be a good alternative treatment. It has become second in popularity for facial paralysis reconstruction in the authors' center.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Taipei-Linkou, Taiwan From the Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University.
authors.forename: David Chwei-Chin
authors.initials: DC
authors.lastname: Chuang
authors.forename: Johnny Chuieng-Yi
authors.initials: JC
authors.lastname: Lu
authors.forename: Katerina
authors.initials: K
authors.lastname: Anesti
mesh_terms: D000055:Accessory Nerve / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005149:Facial Expression; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D016067:Nerve Transfer / Q000379:methods*; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult